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448 Stage migration in patients with lymph node positive cervical cancer
  1. T Fahmy1 and
  2. M Persic2
  1. 1Barts and The London School of Medicine and Dentistry, United Kingdom
  2. 2Royal Derby Hospital, United Kingdom


Introduction/Background*Cervical cancer is the most common gynaecological malignancy worldwide. Despite strides in disease prevention with HPV (human papillomavirus) vaccination, and early detection of pre-cancerous changes, cervical cancer is nonetheless associated with high mortality. Survival is strongly linked to initial FIGO (International Federation of Gynaecology and Obstetrics) disease stage at diagnosis. In 2018, the FIGO staging criteria for cervical cancer were revised to include lymph node status, with positive nodes upstaging patients to stage 3C disease. This resulted in a retrospective stage migration for many patients. This study aims to analyse the effect of stage migration in cervical cancer on disease survival and systemic recurrence.

Methodology Data from a cohort of 76 cervical cancer patients from the University Hospital of Derby and Burton NHS Trust diagnosed and treated with chemoradiation and brachytherapy from 2012–2017 were collected. Patients with positive lymph nodes at diagnosis were assigned a new stage based on the current 2018 FIGO criteria and subsequently compared to patients whose stage at initial diagnosis remained unchanged.

Result(s)*46% of patients were assigned a new higher stage based on lymph node status at diagnosis as per 2018 FIGO staging. An approximate 2.5x increase in cancer-related mortality was seen amongst those who had stage migrated versus those who remained the same stage (37.14% versus 14.63%, p=0.024). Furthermore, a non-significant difference was seen in rates of systemic recurrence between the two groups, with around twice as many of the lymph node positive patients recurring within the timeframe of the study (40.00% compared with 19.51%, p=0.05).

Conclusion*These results reinforce the importance in the inclusion of lymph node status within 2018 FIGO staging criteria owing to the significant effect upon mortality in those who had stage migrated. The poorer prognosis and survival in the stage migration group also highlights the need for aggressive intervention in those with positive lymph nodes.

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